Scaling Contraceptive Access in Primary Care

On December 18, 2024, the Primary Care Collaborative (PCC) and Upstream USA hosted a webinar on improving access to contraceptive care through primary care. Panelists included Angeline Ti, MD, MPH (Wellstar Douglas Family Residence Program; Upstream USA), Jessica Marcella (previously HHS Office of Population Affairs) and Julia Strasser, DrPH, MPH (Jacobs Institute of Women’s Health, GWU Milken) with Ann Greiner (PCC) moderating.

Greiner opened the webinar by highlighting the issue of "contraceptive deserts," where 19 million women lack access to a full range of contraceptive options, often due to limited OB-GYN availability. She emphasized primary care’s critical role in bridging these gaps, as many women rely on primary care clinicians for routine health needs.

Marcella then emphasized primary care’s accessibility and continuity and the need for systemic support to sustain contraceptive services. This reinforced primary care’s potential to expand equitable access to reproductive health care.

Dr. Ti discussed primary care’s strengths in providing patient-centered contraceptive care, addressing barriers like geographic and financial challenges and the need for systems to support high-quality services. She also noted family medicine residents' eagerness to provide this care, underscoring the need for a supportive culture within our health system.

Dr. Strasser highlighted the variations in contraceptive care across specialties, noting the importance of primary care in contraception access, especially in underserved areas. She called for training and policy support to help primary care clinicians expand their roles.

Ti then discussed barriers to comprehensive contraceptive care, including insufficient residency training, short appointment times and lack of patient awareness. She emphasized the need for robust training, adequate appointment time and proactive screening for contraception care.

Continuing this conversation, Strasser highlighted the impact of COVID-19 on the health care workforce, noting the drop in physicians providing contraception in 2020, though it rebounded in 2021. She stressed the need for supportive policies to help primary care clinicians manage these challenges.

Marcella also emphasized that access to contraception affects not only pregnancy outcomes but also financial stability and overall health. She underscored primary care’s role in helping patients navigate these challenges.

Regarding federal reform, Marcella called for funding for patient-centered care, training and public education, and emphasized the need for full insurance coverage, particularly for underserved populations. She pointed to resources like MediCal eligibility criteria and family planning guidelines.

Strasser discussed policies addressing systemic racism and mistrust in reproductive health care, suggesting expanding programs like the Teaching Health Center Graduate Medical Education Program (THCGME) to increase Medicaid acceptance and training. She also called for easing scope-of-practice restrictions for advanced practice clinicians.

Ti emphasized balancing quality metrics with patient satisfaction while avoiding coercion or bias. She highlighted challenges like prior authorization for IUDs and implants and suggested the need for hands-on procedural training to reduce these barriers.

Strasser stressed that contraception promotes self-determination and bodily autonomy and called for a robust primary care workforce to provide a full range of contraceptive methods. She emphasized that while only 60% of U.S. counties have an OB-GYN or nurse midwife, over 90% have family medicine physicians.

Marcella discussed the Affordable Care Act’s strides in covering contraception without cost sharing but noted gaps, such as the lack of coverage for some methods and populations, like those on Medicare due to disability. She also highlighted insurance affordability as a barrier to access.

Strasser then addressed potential Medicaid cuts, including block granting and work requirements, which could reduce eligibility and access to care. She warned that increased administrative burdens could further limit clinician participation in Medicaid, reducing access to contraceptive care.

Marcella pointed out the impact of state budget deficits on Medicaid reimbursement rates for family planning services and emphasized the need to advocate for family planning amidst competing health priorities.

Ti suggested that professional boards could improve contraceptive care by adding more related questions to board exams and requiring specific training. She also recommended offering accessible resources, such as webinars, and collaborating across boards to share strategies for supporting providers.

PCC is also looking for feedback on the webinar and the primary care community's interest in strengthening efforts to scale contraceptive care. To provide feedback, please watch the webinar and respond to the survey here.